Despite the enthusiasm of earlier reports, our initial experience with grey-scale, real-time, B-mode US suggests it is not a reliable alternative to nasopharyngoscopy for assessing vocal cord function post-thyroid and post-parathyroid surgery. Further recruitment of patients with known vocal cord palsy is required to confirm or refute these initial impressions.

Background: Operating theatre inefficiency and changeover delays are not only a significant source of wasted resources, but also a familiar source of frustration to patients and health-care providers. This study aimed to prove that the surgical registrar through active involvement in patient changeover can significantly improve operating room efficiency and minimize delays. Methods: A two-phase prospective cohort study was undertaken, conducted over the course of 4 weeks at a single institution. The only inclusion criteria comprised patients to undertake endoscopic urological day surgery cases and require general anaesthesia. There were no exclusions. In the first phase (observational, with no intervention), changeover times between cases were documented. The second phase followed a structured intervention, involving the surgical registrar being actively involved in the patient's operative journey. Outcome measures were qualitative measures of operative efficiency. Statistical analysis was undertaken. Results: There were 42 patients included in this study, with 21 patients in each of its arms. A 48% (P-value < 0.01) reduction in overall case changeover times was demonstrated with the utilization of a structured intervention from 27.7 min (95% confidence interval (CI) 22.8-32.7%) to 15.7 min (95% CI 13.2-18.2%). The intervention results were statistically significant (P-value < 0.05) for all markers of efficiency except for the waiting time in the anaesthetic holding bay (P-value 0.13). Conclusion:The surgical registrar can improve operating room efficiency by using a structured intervention, ultimately reducing patient changeover times.

Study Type – Prognosis (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Hypertension and diabetes have long been identified as both initiating and progressing factors in chronic kidney disease, as well as predictors of long‐term renal impairment in individuals undergoing nephrectomy. Radical nephrectomy itself is an independent risk factor for chronic kidney disease and its associated increased risk of morbid cardiac events and death. These data have been used to support the argument for greater use of partial nephrectomy when dealing with small renal masses. Whilst in the past it has always been seen as intuitive that patients with hypertension and diabetes would have worse renal function after removal of a kidney for malignancy, the present study is the first to quantify this fact. This information could be used to identify those patients who would benefit from early intervention to delay the progression of chronic kidney disease, as well as those for whom partial nephrectomy might be a more appropriate surgical option. OBJECTIVE To quantify the effect of hypertension and diabetes – which have been identified as both initiating and progressing factors in chronic kidney disease (CKD), as well as predictors of long‐term renal impairment in patients undergoing nephrectomy – on renal function after unilateral nephrectomy for malignancy. PATIENTS AND METHODS A retrospective analysis was carried out of 80 unilateral nephrectomies performed at the Wagga Wagga Base Hospital, Calvary Private Hospital and Austin Hospital from January 2007 to December 2009. Prognostic variables were patient age, sex and the presence of hypertension or diabetes. The percentage reduction in glomerular filtration rate (GFR) after nephrectomy was measured and compared between variables using a two‐sample Student’s t‐test. RESULTS All patients who had diabetes also had hypertension. Of the 80 patients, 22 (27.5%) fulfilled the criteria for CKD with a preoperative GFR < 60 mL/min. Patients with hypertension and diabetes had a significantly greater percentage reduction in postoperative GFR (36 ± 2%) than those who had neither risk factor (23 ± 2%, P < 0.003). A similar finding was observed for patients with hypertension alone (32 ± 1%, P < 0.009). The difference in postoperative GFR reduction between diabetics and those with hypertension alone was not statistically significant (P= 0.205). The differential reduction in GFR in patients with CKD risk factors persisted at 3–12 months follow‐up. CONCLUSIONS An increased percentage reduction in GFR is seen in patients with hypertension and diabetes undergoing unilateral nephrectomy for malignancy. These data could be used to identify those patients who would benefit from early referral and subsequent intervention to delay the progression of CKD, as well as those for whom nephron‐sparing surgery might be a more appropriate surgical option.

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